Sepsis profile among preterm infants with enterostomy and fecal transfer: a multicenter retrospective cohort study

Very low birth weight infants (VLBWI, < 1500 g) with abdominal complications often require enterostomy, interrupting physiological intestinal passage. Mucous fistula refeeding (MFR; fecal transfer) aims to restore intestinal continuity and to improve nutrient absorption, yet concerns about infection risk persist. In this multicenter retrospective study, we evaluated the association between MFR and clinical risk profiles in VLBWI with enterostomy until stoma reversal. VLBWI with enterostomy were treated between 2009 and 2022 in five centers of the German Neonatal Network (GNN). Data of infants were grouped by local refeeding practice (MFR vs. no MFR). Logistic regression analyses assessed infections, cholestasis, and growth outcomes, adjusted for gestational age, birth weight, central line use, probiotic use, and antibiotic exposure. Of 60 infants, 26 received MFR and 34 did not. MFR infants showed lower rates of blood-culture–proven sepsis (11.5% vs. 36.4%, p = 0.03) and clinical sepsis (50.0% vs. 78.8%, p = 0.02). Recurrent infections occurred less often (46.2% vs. 75.8%, p = 0.02). Cholestasis and growth parameters were comparable. MFR remained independently associated with reduced odds of blood-culture–proven sepsis (OR 0.22 [95% CI 0.05–0.97], p = 0.046) and clinical sepsis (OR 0.10 [95% CI 0.02–0.58], p = 0.010). MFR in preterm infants with enterostomy was associated with lower sepsis rates supporting its potential as a safe intervention. Standardized refeeding protocols and prospective studies are warranted to confirm these benefits and to evaluate long-term outcomes after stoma reversal.